Application for Service

This is the form that I have potential play partners fill out. I am aware that it is lengthy, and will take a few minutes from your day. I appreciate the effort that you will take in filling it out & sending it to me, as I am sure you will appreciate the effort I take in studying it to create a scene that fulfills both your needs and my desires.

If you have any problems submitting this form click here to download it as a doc file you can fill out and e-mail to me

Thank you for your time.

Name (or Alias) ·

Age ·

City of Residence ·

Email Address (I need some way to contact you back!)·

Do you have a history of problems with? (Check all that apply)

Heart

Lungs

Neck

Back

Joints

Knees

Kidneys

Liver

Nervous System

Mental

Dizzy Spells

Seizures

Diabetes

Blood Sugar

High/Low Blood Pressure

Fainting

Asthma

Hyperventilation

Mouth Breathing

If any of the above questions were answered yes, please elaborate:

Yes
No ·
Do you wear contact lenses?

Describe any phobias you may have:

Describe any allergies you may have:

List any medications you are currently taking:

Yes
No ·
Have you ever tested positive for any STD's?*

If yes, please elaborate:

When were you last checked for STD's?

Yes
No ·
Have you played in the past?*

If yes, please tell me a bit about your past experiences. What was enjoyable, and what was not:

What Social·Media·Historical figures do you picture when you think of Dominant women?(When you close your eyes and fantasize, what does your dream Dominant woman look like...
Catwoman? A school teacher? A nurse? A schoolgirl? Tell me about her.)

Use the drop-downs to rate your interest/appeal in the following roleplay scenes:

· Captive

· Mistress & Slave

· Servant & Butler

· Crossdressing

· Pony Boy

· Puppy Boy

· Piggy Boy

· Age Play

· Fear Play

· Medical Scenes

· Interrogations

· Serving as Furniture

· Shaving (Body)

· Shaving (Face)

· Shaving (Head)

Please elaborate on these:

Use the drop-downs to rate your interest/appeal in the following roleplay scenes:

· Rope

· Tape

· Handcuffs & Metal Bondage

· Leather

· Suspension

· Mummification

· Gas Masks

· Anaesthesia Masks

· Arm Binders

· Hood

· Hands in Front of Body

· Hands Behind Body

· Hands to Ankles (Hogtie)

· Collar & Leash

· Gates of Hell

· Slings/Swings

· Straight Jacket

· Spreader Bars

· Knees Tied

· Elbows Tied

· Tied to a Chair

· Tied to a Bed

· Blindfold

· Bit Gag

· Ball Gag

· Inflatable Gag

· Panty Gag

· Dental Gag

Please elaborate on these:

Use the drop-downs to rate your interest/appeal in the following sensations:

· Spanking

· Paddling

· Flogging

· Caning

· Face Slapping

· Pinching

· Finger Nails

· Nipple Clamps

· Gental Clamps

· Clamps Elsewhere

· Hot Wax

· Ice

· Tickling

· Foot Torture

· Cock Rings

· Knife Play

· Scratching

· Tens Unit

· Violet Wand

· Abrasion

· Belts/Straps

· Electric Flyswatter

· Cupping/Suction

· Fire Play

· Hair Pulling

· Needle Play

· Speculums

Please elaborate on these:

Use the drop-downs to rate your interest/appeal in the following humilation scenarios:

· Verbal Abuse

· Enemas

· Forced Exhibitionism

· Spitting

· Forced Feminization

· Foot Worship

· Diapers

· Chamber Pots

· Tasting Yourself

· Begging

· Caging

· Chastity Devices

· Catheterization

· Crawling

· Anal Dildos

· Anal Fingering

· Anal Fisting

· Erotic Dance

· Physical Examination

· Homage w/ Tongue

· High Heel Worship

· Standing in Corner

· Sucking a Dildo?

Please elaborate on these:

How do you look & sound when a scene IS working for you?

How do you look & sound when a scene IS NOT working for you?

Yes
No ·
Is it acceptable to leave marks?

Yes
No ·
Visible under street clothes?

Yes
No ·
Visible under swimwear?

Yes
No ·
Do you have a history of marking easily?

Are you sensitive to?
NonePerfumesCandlesIncenseOther Scents

How important is physical release to you to feel a scene was fulfilling?

What type of Aftercare do you like, & who do you like to recieve it from?(Aftercare is how you like to being treated when a scene is over.)